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2. Life-long Monitoring of Frail Patients With Chronic Diseases

Author

European Commission, Local Health Authorities n. 4, Local Health Authorities n. 7, Local Health Authorities n. 9, Local Health Authorities n. 12, Local Health Authorities n. 13, Local Health Authorities n. 16, Local Health Authorities n. 20, and SIMG (Italian College of General Medicine)

Published
2015

3. INCIDENCE AND PROGNOSTIC INDEX OF SECONDARY BACTERIAL INFECTION IN COVID 19 PNEUMONIA

Author

1Dr. K. Suresh (Professor & Head, Dept. of General Medicine), 2Dr. Varsha C. ( Post Graduate Dept. of General Medicine), 3Dr. Ramesh Gopi ( Assistant Professor Dept. of General Medicine) 4Dr. Mythreini ( Senior Resident Dept. of General Medicine)

Abstract

Aim & Objectives: 1.To study incidence of secondary bacterial infection in covid 19 pneumonia, 2.To find the outcome of covid 19 patient with concomittent infection. Material and Methods: This is a Single Centre, Retrospective medical record based cohort study done in inpatients of COVID -19 RTPCR positive with clinically and Radiological findings suggestive of COVID -19 at Sri Venkateshwaraa Medical College Hospital and Research Centre. Results: Based on culture findings, about 15% of the COVID19 patients had secondary bacterial infection. The commonest bacteria were Pseudomonas followed by E. coli, Klebsiella and Enterococci. Diabetes is a major risk factor for the secondary bacterial infection among COVID 19 patients. Keywords: Secondary Bacterial Infection, Pseudomonas, E. Coli., Diabetes Pateint, Covid-19

Published
2022
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4. An unusual cause of orthopnoea-hashimoto's thyroiditis presenting as bilateral diaphragmatic palsy

Author

N.K. Thulaseedharan, MBBS, MD(General Medicine), P. Geetha, MBBS, MD(General Medicine), N. Arathi, MBBS, MD(General Medicine), V.K. Shameer, MBBS, MD(General Medicine), N.V. Jayachandran, MBBS, MD(General Medicine), Gomathy Subramaniam, MBBS, MD(Radiodiagnosis), and Santhosh Narayanan, MBBS, MD(General Medicine)

Subjects
Hypothyroidism, Diaphragmatic palsy, Orthopnoea, hashimoto's thyroiditis, Diseases of the respiratory system, RC705-779
Abstract

We report a case of 36 yr old male without any comorbidities, who presented with a history of gradually progressive dyspnoea and orthopnoea for 6 months. Physical examination revealed bradycardia, paradoxical respiration suggestive of bilateral diaphragmatic palsy. Fluoroscopy demonstrated the presence of bilateral diaphragmatic paralysis. Etiological work up showed evidence of autoimmune hypothyroidism due to hashimoto's thyroiditis. Other possibilities were ruled out with appropriate tests. He was started on thyroxine and showed symptomatic improvement.

Published
2017
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5. STUDY OF PULMONARY FUNCTION TEST IN TYPE 2 DIABETES MELLITUS WITH SPECIAL REFERENCE TO DURATION OF DIABETES, GLYCEMIC CONTROL AND MICROVASCULAR COMPLICATIONS

Author

1 Dr. Mamatha B Patil, MD General Medicine, Professor, Rajarajeswari Medical College And Hospital, Bengaluru 2 Dr Faris Unnian K P, MD General Medicine, Assistant Surgeon, Community Health Centre, Shoranur, Palakkad, Kerala 3 Dr Ashwathi A K, Dr Swati Rajan, Junior Residents, General Medicine, Rajarajeswari Medical College And Hospital, Bengaluru

Abstract

Background: The lung is rich in microvascular circulation and abundant connective tissue, that raises the possibility of pulmonary damage by microangiopathic process and non enzymatic glycosylation of tissue proteins induced by chronic hyperglycemia, rendering the lung a target organ in diabetic patients. This study pertains to corelate the effect of duration of diabetes, glycemic status and association of microvascular complications with PFT Objectives: To study the effect of duration of diabetes mellitus and glycemic status on pulmonary function test, and to determine the association of microvascular complications in relation with PFT Methods: 100 patients of both genders with type 2 diabetes mellites in the age group of 30 to 65 years with multiple exclusion criteria were subjected for detailed history, examination, and investigations to rule out microvascular complications including HbA1c, microalbuminuria, fundoscopy, nerve conduction velocity study and PFT. Results: Among the 100 patients studied, as the duration of the illness progressed, there was a significant reduction in PFT. There was no association between HbA1c and PFT. FVC and FEV1 were reduced in patients with microvascular complications, of which diabetic nephropathy was closely associated with PFT and diabetic retinopathy was the most common microvascular complication. 67% of patients had restrictive pattern and 3% had obstructive pattern of lung impairment Conclusion: The PFT parameters were affected more with longer duration of diabetes mellites. Strict glycemic control and regular breathing exercises to strengthen the respiratory muscles may improve the PFT. Spirometry helps in early detection and preventive measures can be advised Keywords: Hyperglycemia, pulmonary function test, microvascular complications, HbA1c, diabetes mellitus, forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV1)

Published
2022
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6. Kinesitherapy for Patients on Hemodialysis

Author

Bliznakova, Magdalena, Department of General Medicine, Faculty of Medicine, Medical University of Varna, Momcheva, Irina, Hristova, Ivelina, Hristova, Eva, Ruseva, Zhenya, and Madjova, Valentina

Subjects
physiotherapy, kinesitherapy, hemodialysis, chronic kidney disease
Abstract

Introduction: Chronic kidney disease (CKD) is a huge challenge for GPs and nephrologists. Physiotherapists are increasingly included in the multidisciplinary teams dealing with CKD around the world to improve the quality of life and prevent a number of complications of patients undergoing the most common treatment for CKD, namely hemodialysis.Aim: The aim of this article is to present the possibilities for optimizing and supporting the motor activity of hemodialysis patients.Materials and Methods: Review of medical literature from the last 10 years, published in the scientific databases: Pubmed, Google Scholar, PubMed Central, and ScienceDirect, has been conducted.Results: Numerous independent studies have shown that kinesitherapy is a reliable aid in the prevention of cardiovascular diseases and in improving the overall condition of patients with CKD on hemodialysis. The implementation of specialized devices for kinesitherapy during hemodialysis and the selection of appropriate exercises to practice at home also show a significant improvement in mental health (motivation for a better and more active life) of hemodialysis patients.Conclusion: The inclusion of kinesitherapy during hemodialysis and acquainting chronically ill patients with the opportunities for improving their physical activities would lead to improved health status and quality of life of these patients.

Published
2022

8. Kallmann Syndrome and Chronic Myeloid Leukemia: A Rare Occurrence

Author

Neelam N, Redkar, Udit, Saraf, Rajit, Pillai, and Kavita J, RawatAssociate Professor In General Medicine Seth G S Medical College And K E M H Mumbai Maharashtra

Subjects
Adult, Male, Leukemia, Myelogenous, Chronic, BCR-ABL Positive, Humans, Kallmann Syndrome
Published
2016

10. Frequency, nature, effects, and correlates of conflicts of interest in published clinical cancer research

Author

Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan ; Fax: (734) 763-7370 ; Department of Radiation Oncology, University of Michigan, UHB2C490, SPC 5010, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5010, University of Michigan Medical School, Ann Arbor, Michigan, Division of General Medicine, Department of Internal Medicine, Center for Behavioral and Decision Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, Division of General Medicine, Department of Internal Medicine, Center for Behavioral and Decision Sciences in Medicine, University of Michigan, Ann Arbor, Michigan ; Department of Internal Medicine, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan, Jagsi, Reshma, Sheets, Nathan, Jankovic, Aleksandra, Motomura, Amy R., Amarnath, Sudha, Ubel, Peter A., Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan ; Fax: (734) 763-7370 ; Department of Radiation Oncology, University of Michigan, UHB2C490, SPC 5010, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5010, University of Michigan Medical School, Ann Arbor, Michigan, Division of General Medicine, Department of Internal Medicine, Center for Behavioral and Decision Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, Division of General Medicine, Department of Internal Medicine, Center for Behavioral and Decision Sciences in Medicine, University of Michigan, Ann Arbor, Michigan ; Department of Internal Medicine, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan, Jagsi, Reshma, Sheets, Nathan, Jankovic, Aleksandra, Motomura, Amy R., Amarnath, Sudha, and Ubel, Peter A.

Abstract

BACKGROUND: Relationships between clinical researchers and industry are becoming increasingly complex. The frequency and impact of conflicts of interest in the full range of high-impact, published clinical cancer research is unknown. METHODS: The authors reviewed cancer research published in 8 journals in 2006 to determine frequency of self-reported conflicts of interest, source of study funding, and other characteristics. They assessed associations between the likelihood of conflicts of interest and other characteristics by using chi-squared testing. They also compared the likelihood of positive outcome in randomized trials with and without conflicts of interest by chi-squared testing. RESULTS: The authors identified 1534 original oncology studies; 29% had conflicts of interest (including industrial funding) and 17% declared industrial funding. Conflicts of interest varied by discipline ( P < .001), continental origin ( P < .001), and sex ( P < .001) of the corresponding author and were most likely in articles with corresponding authors from departments of medical oncology (45%), those from North America (33%), and those with male first and senior authors (37%). Frequency of conflicts also varied considerably depending upon disease site studied. Studies with industrial funding were more likely to focus on treatment (62% vs 36%; P < .001), and randomized trials that assessed survival were more likely to report positive survival outcomes when a conflict of interest was present ( P = .04). CONCLUSIONS: Conflicts of interest characterize a substantial minority of clinical cancer research published in high-impact journals. Therefore, attempts to disentangle the cancer research effort from industry merit further attention, and journals should embrace both rigorous standards of disclosure and heightened scrutiny when conflicts exist. Cancer 2009. ?? 2009 American Cancer Society.

Published
2009

11. Surgeon perspectives about local therapy for breast carcinoma

Author

Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan ; Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan ; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan ; Fax: (734) 936-8944 ; Department of Health Management and Policy, University of Michigan, 300 N. Ingalls, Suite 7E12, P. O. Box 0429, Ann Arbor, MI 48109-0429, Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan, Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan, Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan ; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, Department of Family Medicine, Wayne State University, Detroit, Michigan ; Karmanos Cancer Institute, Wayne State University, Detroit, Michigan, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, Katz, Steven J., Lantz, Paula M., Janz, Nancy K., Fagerlin, Angela, Schwartz, Kendra, Liu, Lihua, Deapen, Dennis, Salem, Barbara, Lakhani, Indu, Morrow, Monica, Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan ; Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan ; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan ; Fax: (734) 936-8944 ; Department of Health Management and Policy, University of Michigan, 300 N. Ingalls, Suite 7E12, P. O. Box 0429, Ann Arbor, MI 48109-0429, Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan, Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan, Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan ; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, Department of Family Medicine, Wayne State University, Detroit, Michigan ; Karmanos Cancer Institute, Wayne State University, Detroit, Michigan, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, Katz, Steven J., Lantz, Paula M., Janz, Nancy K., Fagerlin, Angela, Schwartz, Kendra, Liu, Lihua, Deapen, Dennis, Salem, Barbara, Lakhani, Indu, and Morrow, Monica

Abstract

BACKGROUND Geographic variations in the use of mastectomy and the use of radiation therapy (RT) after breast-conserving surgery (BCS) have motivated concerns that surgeons are not uniformly adhering to treatment standards. METHODS The authors surveyed attending surgeons of a population-based sample of patients with breast carcinoma diagnosed in Detroit and Los Angeles from December 2001 to January 2003 ( n = 365; response rate, 80.0%). Clinical scenarios were used to evaluate opinions about local therapy. RESULTS On average, surgeons reported that they devoted 31.3% of their total practice to breast carcinoma. Approximately one-half of surgeons practiced in a community hospital setting, whereas 18.8% practiced in a cancer center. Compared to low volume surgeons, high volume surgeons were more likely to favor BCS with RT for invasive breast carcinoma (60.8%, 74.0%, and 87.2% for low, moderate, and high volume surgeons, respectively, P < 0.001). Surgeons who favored BCS were more likely to perceive greater quality of life (QOL) benefits for BCS than mastectomy (85.9%) compared with surgeons who favored mastectomy (28.6%) and those who did not favor 1 procedure over the other (60.0%, P < 0.001). In a ductal carcinoma in situ scenario, 35.0% of surgeons favored BCS without RT and 61.0% favored BCS with RT. Opinions regarding the role of RT after BCS varied by geographic site, surgeon volume, and patient age. CONCLUSIONS Variation in surgeon opinion concerning local therapy reflected clinical uncertainty about the benefits of alternative treatments. High volume surgeons more frequently endorsed current clinical guidelines that favor BCS compared with mastectomy. This may partly be explained by the greater belief that BCS confers a better patient QOL than mastectomy. Cancer 2005. ?? 2005 American Cancer Society.

Published
2006

12. [原著］Age related changes in event-related potentials and psychological testing in healthy elderly subjects

Author

Yu, Jin, Hiramatsu, Kenichi, Shimazaki, Yoriyuki, Takeda, Yuko, and Center for General Medicine, University of the Ryukyus

Subjects
Aging, Elderly, P300, MMS, Event-related potentials
Abstract

P300 latency in event-related potentials (ERPs) have been assumed to increase with age, and to be roughly correlated with loss of cognitive functions. However, is P300 latency prolonged in all elderly subjects? To address this question, we selected 63 subjects from 60 to 91 years of age. Subjects were active, living at home, free from psychiatric or significant physical disorders, having high Mini-Mental State (MMS) score and low Geriatric Depression Scale (GDS) score, and showed no major signs of cerebral infarction on MRI (1.5T). ERPs were recorded with subjects engaged in auditory oddball tasks. We found no significant correlation between age and P300 component. Sex difference concerning P300 component with aging was also not detected. P300 latency prolongation and decreased visual retention (Benton test) were associated with lower MMS score, and visual retention was correlated with age. We conclude that P300 latency does not increase linearly with age in elderly subjects and that prolongation of latency is affected by subclinical organic changes in the brain than by aging itself.

Published
2002

14. Use of Urinary Collection Devices in Skilled Nursing Facilities in Five States

Author

School of Public Health, University of Michigan, Ann Arbor, Michigan, Patient Safety Enhancement Program, Veterans Affairs Medical Center and University of Michigan Health System, Ann Arbor, Michigan, Geriatric Research, Education, and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan ; and, Center for Practice Management and Outcomes Research, Ann Arbor Veterans Affairs Health Services Research and Development Center of Excellence, Ann Arbor, Michigan, General Medicine and, Geriatric Medicine, Department of Internal Medicine, Institute of Gerontology, School of Medicine, Rogers, Mary A. M., Mody, Lona, Kaufman, Samuel R., Fries, Brant E., McMahon, Laurence F., Saint, Sanjay, School of Public Health, University of Michigan, Ann Arbor, Michigan, Patient Safety Enhancement Program, Veterans Affairs Medical Center and University of Michigan Health System, Ann Arbor, Michigan, Geriatric Research, Education, and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan ; and, Center for Practice Management and Outcomes Research, Ann Arbor Veterans Affairs Health Services Research and Development Center of Excellence, Ann Arbor, Michigan, General Medicine and, Geriatric Medicine, Department of Internal Medicine, Institute of Gerontology, School of Medicine, Rogers, Mary A. M., Mody, Lona, Kaufman, Samuel R., Fries, Brant E., McMahon, Laurence F., and Saint, Sanjay

Abstract

To assess use of urinary collection devices (external, intermittent, and indwelling catheters; pads or briefs) and examine predictors of indwelling catheters in skilled nursing facilities (SNFs). DESIGN : Retrospective cohort study. SETTING : SNFs in California, Florida, Michigan, New York, and Texas. PARTICIPANTS : All patients admitted to SNFs in 2003 who remained there for 1 year (N=57,302). MEASUREMENTS : Characteristics of patients who used different collection strategies (indwelling, intermittent, and external catheterization; pads or briefs) and predictors of indwelling urinary catheterization from the Nursing Home Minimum Data Set using multinomial logistic regression. RESULTS : The prevalence of indwelling catheterization was 12.6% at admission and 4.5% at the annual assessment ( P <.001). Intermittent and external catheterization were infrequently used (<1% at admission and annual assessment). Paraplegia, quadriplegia, multiple sclerosis, and comatose state were strongly associated with indwelling catheterization. Male residents were more likely to use an indwelling catheter at every assessment, as were obese patients; individuals with diabetes mellitus, renal failure, skin conditions, deep vein thrombosis, aphasia, or end-stage disease; and those who were taking more medications. CONCLUSION : Coinciding with federal regulations, urinary catheterization was lower than has been reported previously and declined over time. Further reduction should be targeted at the evaluation of skin problems, appropriateness of multiple medications, and alternative measures in patients with diabetes mellitus, obesity, deep vein thrombosis, and communication problems.

Published
2010

15. Hospitalist time usage and cyclicality: Opportunities to improve efficiency

Author

Division of General Internal Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan ; Telephone: 734-647-2892; Fax: 734-615-8401 ; MD, MBA, Assistant Professor, Internal Medicine, Assistant Professor, Pediatrics and Communicable Diseases, University of Michigan Medical School, Division of General Medicine, Department of Internal Medicine, 3119 Taubman Center, Box 5376, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5376, Ross School of Business, University of Michigan, Ann Arbor, Michigan, Division of General Internal Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, Kim, Christopher S., Lovejoy, William, Paulsen, Michael, Chang, Robert, Flanders, Scott A., Division of General Internal Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan ; Telephone: 734-647-2892; Fax: 734-615-8401 ; MD, MBA, Assistant Professor, Internal Medicine, Assistant Professor, Pediatrics and Communicable Diseases, University of Michigan Medical School, Division of General Medicine, Department of Internal Medicine, 3119 Taubman Center, Box 5376, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5376, Ross School of Business, University of Michigan, Ann Arbor, Michigan, Division of General Internal Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, Kim, Christopher S., Lovejoy, William, Paulsen, Michael, Chang, Robert, and Flanders, Scott A.

Abstract

BACKGROUND: Academic medical centers (AMCs) have a constrained resident work force. Many AMCs have increased the use of nonresident service hospitalists to manage continued growth in clinical volume. To optimize their time in the hospital, it is important to understand hospitalists' work flow. DESIGN: We performed a time-motion study of hospitalists carrying the admission pager throughout the 3 types of shifts we have at our hospital (day shift, swing shift, and night shift). SETTING: Tertiary academic medical center in the Midwest. RESULTS: Hospitalists spend about 15% of their time on direct patient care, and two-thirds of their time on indirect patient care. Of the indirect activities, communication and documentation dominate. Travel demands make up over 7% of a hospitalists' time. There are spikes in indirect patient care, followed closely by spikes in direct patient care, at shift changes. CONCLUSIONS: At our AMC, indirect patient care activities accounted for the majority of the admitting hospitalists' time spent in the hospital, with documentation and communication dominating this time. Travel takes a significant fraction of hospitalists' time. There is also a cyclical nature to activities performed throughout the day, which can cause patient delays and impose variability on support services. There is a need for both service-specific and systemic improvements for AMCs to efficiently manage further growth in their inpatient volume. Journal of Hospital Medicine 2010;5:329???334. ?? 2010 Society of Hospital Medicine.

Published
2010

16. Understanding the variation in treatment intensity among patients with early stage bladder cancer

Author

Robert Wood Johnson Foundation Clinical Scholar Program, University of Michigan, Ann Arbor, Michigan ; Department of Urology, Division of Health Services Research, University of Michigan, Ann Arbor, Michigan, Department of Urology, Division of Health Services Research, University of Michigan, Ann Arbor, Michigan, Veterans Affairs Ann Arbor Healthcare System, Center for Practice Management and Outcomes Research, Ann Arbor, Michigan ; Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, Department of Urology, Division of Health Services Research, University of Michigan, Ann Arbor, Michigan ; Michigan Surgical Collaborative for Outcomes Research and Evaluation, Ann Arbor, Michigan ; Fax: (734) 232-2400 ; Department of Urology, The University of Michigan, Room 1032B, Michigan House, 2301 Commonwealth Boulevard, Ann Arbor, MI 48105-2967, Hollingsworth, John M., Zhang, Yun, Krein, Sarah L., Ye, Zaojun, Hollenbeck, Brent K., Robert Wood Johnson Foundation Clinical Scholar Program, University of Michigan, Ann Arbor, Michigan ; Department of Urology, Division of Health Services Research, University of Michigan, Ann Arbor, Michigan, Department of Urology, Division of Health Services Research, University of Michigan, Ann Arbor, Michigan, Veterans Affairs Ann Arbor Healthcare System, Center for Practice Management and Outcomes Research, Ann Arbor, Michigan ; Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, Department of Urology, Division of Health Services Research, University of Michigan, Ann Arbor, Michigan ; Michigan Surgical Collaborative for Outcomes Research and Evaluation, Ann Arbor, Michigan ; Fax: (734) 232-2400 ; Department of Urology, The University of Michigan, Room 1032B, Michigan House, 2301 Commonwealth Boulevard, Ann Arbor, MI 48105-2967, Hollingsworth, John M., Zhang, Yun, Krein, Sarah L., Ye, Zaojun, and Hollenbeck, Brent K.

Abstract

BACKGROUND: Given the uncertainty surrounding the optimal management for early stage bladder cancer, physicians vary in how they approach the disease. The authors of this report linked cancer registry data with medical claims to identify the sources of variation and opportunities for improving the value of cancer care. METHODS: By using data from the Surveillance, Epidemiology, and End Results-Medicare database (1992-2005), patients with early stage bladder cancer were abstracted (n = 18,276). The primary outcome was the intensity of initial treatment that patients received, as measured by all Medicare payments for bladder cancer incurred in the 2 years after diagnosis. Multilevel models were fitted to partition the variation in treatment intensity attributable to patient versus provider factors, and the potential savings to Medicare from reducing the physician contribution were estimated. RESULTS: Provider factors accounted for 9.2% of the variation in treatment intensity. Increasing provider treatment intensity did not correlate with improved cancer-specific survival ( P = .07), but it was associated with the subsequent receipt of major interventions, including radical cystectomy ( P < .001). If provider-level variation was reduced and clinical practice was aligned with that of physicians who performed in the 25th percentile of treatment intensity, then total payments made for the average patient could be lowered by 18.6%, saving Medicare $18.7 million annually. CONCLUSIONS: The current results indicated that a substantial amount of the variation in initial treatment intensity for early stage bladder cancer is driven by the physician. Furthermore, a more intensive practice style was not associated with improved cancer-specific survival or the avoidance of major interventions. Therefore, interventions aimed at reducing between-provider differences may improve the value of cancer care. Cancer 2010. ?? 2010 American Cancer Society.

Published
2010

17. Quality of life measurement clarifies the cost-effectiveness of Helicobacter pylori eradication in peptic ulcer disease and uninvestigated dyspepsia 1

Author

Division of General Medicine, University of Michigan, Ann Arbor, Michigan, USA, Department of Veterans Affairs Medical Center and University of California, San Francisco, San Francisco, California, USA, Center for Health Policy, Stanford University, Stanford, California, USA, Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School, Boston, Massachusetts, USA, Division of Research, Kaiser Permanente Medical Care Program (Northern California Region), Oakland, California, USA, Department of Gastroenterology, Kaiser Permanente Medical Center, Walnut Creek, California, USA, Division of Gastroenterology, San Francisco General Hospital, San Francisco, California, USA, Northern California Institute for Research and Education, San Francisco, California, USA, Groeneveld, Peter W., Lieu, Tracy A., Fendrick, A. Mark, Hurley, Leo B., Ackerson, Lynn M., Levin, Theodore R., Allison, James E., Division of General Medicine, University of Michigan, Ann Arbor, Michigan, USA, Department of Veterans Affairs Medical Center and University of California, San Francisco, San Francisco, California, USA, Center for Health Policy, Stanford University, Stanford, California, USA, Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School, Boston, Massachusetts, USA, Division of Research, Kaiser Permanente Medical Care Program (Northern California Region), Oakland, California, USA, Department of Gastroenterology, Kaiser Permanente Medical Center, Walnut Creek, California, USA, Division of Gastroenterology, San Francisco General Hospital, San Francisco, California, USA, Northern California Institute for Research and Education, San Francisco, California, USA, Groeneveld, Peter W., Lieu, Tracy A., Fendrick, A. Mark, Hurley, Leo B., Ackerson, Lynn M., Levin, Theodore R., and Allison, James E.

Abstract

Previous economic studies of Helicobacter pylori eradication in dyspepsia and peptic ulcer disease have not measured quality of life using utilities (preference probabilities), which are needed to compare the cost-effectiveness of such treatment to other health care interventions. The goals of this study were to measure quality of life in patients with dyspepsia or peptic ulcer and apply these measurements to published models of disease management to determine cost-effectiveness in dollars per quality-adjusted life year (QALY) gained. Methods : Utilities for dyspepsia and peptic ulcer disease were measured in adult patients (n = 73) on chronic acid suppression for peptic ulcer or ulcer-like dyspepsia. Median utility values were applied to the results of published cost-effectiveness analyses and a previously validated dyspepsia model. Cost-utility ratios for early H. pylori eradication in uninvestigated dyspepsia and peptic ulcer disease were then computed. Results : The total disutility, or lost quality of life, for an ulcer was 0.11 QALY, of which 0.09 QALY was attributed to dyspeptic symptoms. After these results were incorporated into published studies, cost-utility ratios for ulcer treatment varied from $3,100 to $12,500 per QALY gained, whereas estimates for uninvestigated dyspepsia management ranged from $26,800 to $59,400 per QALY. Sensitivity analyses indicated a range of $1,300 to $27,300 per QALY for management of duodenal ulcer and $15,000 to $129,700 per QALY for dyspepsia. Conclusions: Strategies that emphasize early H. pylori eradication were cost-effective for patients with peptic ulcer and possibly cost-effective for patients with uninvestigated dyspepsia, relative to other medical interventions. Dyspeptic symptoms cause significant disutility that should be incorporated in future cost-effectiveness analyses of treatment strategies.

Published
2010

18. Under-representation of women in high-impact published clinical cancer research

Author

Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan ; Fax: (734) 763-7370 ; Department of Radiation Oncology, University of Michigan, UHB2C490, SPC 5010, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5010, Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, University of Michigan Medical School, Ann Arbor, Michigan, Center for Behavioral and Decision Sciences in Medicine, Department of Internal Medicine, Division of General Medicine, University of Michigan, Ann Arbor, Michigan, Jagsi, Reshma, Motomura, Amy R., Amarnath, Sudha, Jankovic, Aleksandra, Sheets, Nathan, Ubel, Peter A., Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan ; Fax: (734) 763-7370 ; Department of Radiation Oncology, University of Michigan, UHB2C490, SPC 5010, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5010, Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, University of Michigan Medical School, Ann Arbor, Michigan, Center for Behavioral and Decision Sciences in Medicine, Department of Internal Medicine, Division of General Medicine, University of Michigan, Ann Arbor, Michigan, Jagsi, Reshma, Motomura, Amy R., Amarnath, Sudha, Jankovic, Aleksandra, Sheets, Nathan, and Ubel, Peter A.

Abstract

BACKGROUND. Adequate representation of women in research has been deemed essential. METHODS. Cancer research published in 8 journals in 2006 was reviewed. The percentage of women among study participants was compared with the proportion expected from population-based estimates of sex-specific cancer incidence, using binomial tests. Differences were assessed in sex distribution of participants by funding source, author sex, and focus of research with the Student t test, and in a linear regression model controlling for cancer type. RESULTS. A total of 1534 cancer research articles were identified, of which 661 (representing 1,096,098 participants) were prospective clinical studies and were analyzed further. For all 7 non-sex???specific cancer types assessed, the majority of studies analyzed included a lower proportion of women than the proportion of women among patients having cancer of that type in the general population. Among studies focusing on cancer treatment, women constituted a significantly lower overall proportion of the participants in the analyzed studies than expected for 6 of 7 non-sex???specific cancer types ( P < .001). Among non-sex???specific studies, the mean percentage of participants who were women was 38.8%. Non-sex???specific studies reporting government funding had a higher percentage of female participants (mean 41.3% vs 36.9%; P = .005). In a regression model controlling for cancer type, lack of government funding ( P = .03) and focus on cancer treatment ( P = .03) were found to be independent significant predictors of a lower percentage of female participants. CONCLUSIONS. Women were under-represented as participants in recently published, high-impact studies of non-sex???specific cancers. Studies that received government funding included a higher proportion of female subjects. Cancer 2009. ?? 2009 American Cancer Society.

Published
2009

19. Understanding the impact of breast reconstruction on the surgical decision-making process for breast cancer

Author

Section of Plastic Surgery, Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan ; Veterans Administration Center for Practice Management and Outcomes Research, Ann Arbor VA Health Care System, Ann Arbor, Michigan ; Fax: (734) 763-5354 ; Plastic and Reconstructive Surgery, University of Michigan, 2130 Taubman Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0340, Veterans Administration Center for Practice Management and Outcomes Research, Ann Arbor VA Health Care System, Ann Arbor, Michigan ; Division of General Medicine, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan, Robert Wood Johnson Clinical Scholars Program and the Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, Alderman, Amy K., Hawley, Sarah T., Waljee, Jennifer, Mujahid, Mahasin, Morrow, Monica, Katz, Steven J., Section of Plastic Surgery, Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan ; Veterans Administration Center for Practice Management and Outcomes Research, Ann Arbor VA Health Care System, Ann Arbor, Michigan ; Fax: (734) 763-5354 ; Plastic and Reconstructive Surgery, University of Michigan, 2130 Taubman Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0340, Veterans Administration Center for Practice Management and Outcomes Research, Ann Arbor VA Health Care System, Ann Arbor, Michigan ; Division of General Medicine, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan, Robert Wood Johnson Clinical Scholars Program and the Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, Alderman, Amy K., Hawley, Sarah T., Waljee, Jennifer, Mujahid, Mahasin, Morrow, Monica, and Katz, Steven J.

Abstract

BACKGROUND. Reconstruction is rarely incorporated into the decision-making process for surgical breast cancer treatment. We examined the importance of knowing about reconstruction to patients' surgical decision-making for breast cancer. METHODS. We surveyed women aged ???79 years with breast cancer (N = 1844) who were reported to the Detroit and Los Angeles Surveillance, Epidemiology, and End Results (SEER) cancer registries (response rate, 77.4%). The dependent variables were 1) patients' report of having a discussion about breast reconstruction with their general surgeon (yes/no), 2) whether or not this discussion had an impact on their willingness to be treated with a mastectomy (yes/no), and 3) whether the patient received a mastectomy (yes/no). The independent variables included age, race, education, tumor size, tumor behavior, and presence of comorbidities. Chi-square, Student t test, and logistic regression were used for analyses. RESULTS. Only 33% of patients had a general surgeon discuss breast reconstruction with them during the surgical decision-making process for their cancer. Surgeons were significantly more likely to have this discussion with younger, more educated patients with larger tumors. Knowing about reconstructive options significantly increased patients' willingness to consider a mastectomy (OR, 2.06; P <.01). In addition, this discussion influenced surgical treatment. Patients who discussed reconstruction with their general surgeon were 4 times more likely to receive a mastectomy compared with those who did not (OR, 4.48; P < .01). CONCLUSIONS. Most general surgeons do not discuss reconstruction with their breast cancer patients before surgical treatment. When it occurs, this discussion significantly impacts women's treatment choice, making many more likely to choose mastectomy. This highlights the importance of multidisciplinary care models to facilitate an informed surgical treatment decision-making process. Cancer 2008. ?? 2007 American Ca

Published
2008

20. Lean health care: What can hospitals learn from a world-class automaker?

Author

Division of General Internal Medicine, University of Michigan, Ann Arbor, Michigan ; Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan ; University of Michigan, Division of General Medicine, Department of Internal Medicine, 3119 Taubman Center, Box 0376, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0376, Division of General Internal Medicine, University of Michigan, Ann Arbor, Michigan, Department of Internal Medicine, Medical School Administration, University of Michigan, Ann Arbor, Michigan, Kim, Christopher S., Spahlinger, David A., Kin, Jeanne M., Billi, John E., Division of General Internal Medicine, University of Michigan, Ann Arbor, Michigan ; Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan ; University of Michigan, Division of General Medicine, Department of Internal Medicine, 3119 Taubman Center, Box 0376, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0376, Division of General Internal Medicine, University of Michigan, Ann Arbor, Michigan, Department of Internal Medicine, Medical School Administration, University of Michigan, Ann Arbor, Michigan, Kim, Christopher S., Spahlinger, David A., Kin, Jeanne M., and Billi, John E.

Abstract

BACKGROUND With health care costs continuing to rise, a variety of process improvement methodologies have been proposed to address the reported inefficiencies in health care delivery. Lean production is one such method. The management philosophy and tools of lean production come from the manufacturing industry, where they were pioneered by Toyota Motor Corporation, which is viewed as the leader in utilizing these performance improvement methods. Lean has already enjoyed tremendous success in improving quality and efficiency in both the manufacturing and the service sector industries. RESULTS Health care systems have just begun to utilize lean methods, with reports of improvements just beginning to appear in the literature. We describe some of the basic philosophy and principles of lean production methods and how these concepts can be applied in the health care environment. We describe some of the early success stories and ongoing endeavors of lean production in various health care organizations. We believe the hospital is an ideal setting for use of the lean production method, which could significantly affect how health care is delivered to patients. CONCLUSIONS We conclude by discussing some of the potential challenges in introducing and implementing lean production methods in the health care environment. Lean production is a novel approach to delivering high-quality and efficient care to patients, and we believe that the health care sector can anticipate the same high level of success that the manufacturing and service industries have achieved using this approach. Hospitalists are primed to take action in delivering care of greater quality with more efficiency by applying these new principles in the hospital setting. Journal of Hospital Medicine 2006;1:191–199. © 2006 Society of Hospital Medicine.

Published
2007

21. Economic immunity in the ICU: continued support or pull the plug?

Author

Division of General Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI 48109, USA, US, Ann Arbor, Fendrick, A.M., Saint, Sanjay, Division of General Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI 48109, USA, US, Ann Arbor, Fendrick, A.M., and Saint, Sanjay

Published
2006

22. Changing patterns of hospital use for patients with musculoskeletal diseases in Michigan, 1980 to 1987

Author

Department of Internal Medicine, School of Medicine, Health Services Management and Policy, and Biostatistics, School of Pubic Health, University of Michigan ; Division of General Medicine, Department of Internal Medicine, University of Michigan Medical Center, 3116 Taubman, Ann Arbor, MI 48109-0376, Department of Internal Medicine, School of Medicine, Health Services Management and Policy, and Biostatistics, School of Pubic Health, University of Michigan, McMahon, Laurence F., Petroni, Gina R., Tedeschi, Philip J., McLaughlin, Catherine G., Department of Internal Medicine, School of Medicine, Health Services Management and Policy, and Biostatistics, School of Pubic Health, University of Michigan ; Division of General Medicine, Department of Internal Medicine, University of Michigan Medical Center, 3116 Taubman, Ann Arbor, MI 48109-0376, Department of Internal Medicine, School of Medicine, Health Services Management and Policy, and Biostatistics, School of Pubic Health, University of Michigan, McMahon, Laurence F., Petroni, Gina R., Tedeschi, Philip J., and McLaughlin, Catherine G.

Abstract

Over the past 10 years there have been dramatic changes in health care financing in the United States, such as Medicare's Prospective Payment System for hospitalized Medicare beneficiaries, and in health services delivery, such as the growth in health maintenance organizations and other forms of managed care. These changes have occurred largely in response to payors' concerns about the rising cost of health care. A study of such changes in financing and delivery, and how specific groups of patients are affected is necessary so that the effects of these changes on patients' health can be determined. We examined the hospitalization rates for patients with musculoskeletal diseases in Michigan from 1980 through 1987. During this period, the overall ageadjusted hospitalization rates decreased 7.0% per year (p = 0.001). The decrease occurred less for surgical discharges (6.0% per year) than for medical discharges (8.6% per year) (p <0.001). While these overall trends are of interest, they obscure disease-specific trends that vary significantly from both the overall, and the medical and surgical trends. For example, while surgical discharges, in general declined, procedures related to major joint and limb reattachment (DRG # 209) increased at a rate of 6.3% per year. And while medical discharges in general decreased over this period, discharges for osteomyelitis increased 5.4% per year. The patterns of diseasespecific trends offers insight into the possible causes for these changes. Finally, it is important to understand the epidemiology of hospital use to evaluate the effects of new medical care delivery and payment systems on the care of subsets of patients.

Published
2006

23. HLA Haplotype Frequency Analysis Within India: Pre-Requisite For Bone Marrow Donor Registry and Cord Blood Bank Planning

Author

Maiers, Martin, Halagan, Michael, Leahy, Nicole, Joshi, Sangeeta, Ballal, H Sudarshan, Jagannathan, Latha, Damodar, Sharat, Srinivasan, Periathiruvadi, Narayan, Saranya, Khattry, Navin, Malhotra, Pankaj, Shah, Sandip A, Rajagopal, Raghu, Cereb, Nezih, Yang, Soo Young, Dedhia, Leenam, Parekh, Sunil, Mammen, Joy J, Daniels, Dolly, and Weisdorf, Daniel J.

Published
2013
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34. A National Study of Intravenous Medication Errors

Author

Johns Hopkins University, Winchester Medical Center, Central DuPage Hospital, Vanderbilt University, Massachusetts General Hospital, University of California, San Diego, Valleywise Health, Danbury Hospital, Association for the Advancement of Medical Instrumentation, CareFusion foundation, Candler Hospital, and David W. Bates, MD, MSc, Chief, Division of General Medicine

Published
2016

36. Insomnia and Drug Relapse Risk

Author

National Institute on Drug Abuse (NIDA) and Michael Stein, MD, Director, General Medicine Research

Published
2013

37. Thermal male contraception: A study of users’ motivation, experience, and satisfaction

Author

Samuel Joubert, Jessica Tcherdukian, Roger Mieusset, Jeanne Perrin, Département de Médecine Générale [CHU Saint-Etienne], Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E)-Université Jean Monnet - Saint-Étienne (UJM), University Department of General Medicine, Faculty of Medicine of Marseille, Aix-Marseille University, Marseille, France, Service Médecine de la Reproduction [CHU Toulouse], Pôle Femme-Mère-Couple [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Développement Embryonnaire, Fertilité et Environnement (DEFE), Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), AMP-CECOS Clinical-Biological Centre, AP-HM La Conception University Hospital, Marseille, France, Institut méditerranéen de biodiversité et d'écologie marine et continentale (IMBE), Avignon Université (AU)-Aix Marseille Université (AMU)-Institut de recherche pour le développement [IRD] : UMR237-Centre National de la Recherche Scientifique (CNRS), Centre Clinico-Biologique d’Assistance Médicale à la Procréation - CECOS [Hôpital de la Conception - APHM], Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), and Aix Marseille Université (AMU)

Subjects
Male, contraceptive devices, [SDV.EE.SANT]Life Sciences [q-bio]/Ecology, environment/Health, Motivation, men acceptance of health care, contraceptive devices couple male thermal contraception men acceptance of health care men satisfaction sexual satisfaction, Urology, Endocrinology, Diabetes and Metabolism, [SDV.BDLR]Life Sciences [q-bio]/Reproductive Biology, Personal Satisfaction, Hormones, men satisfaction, Contraception, Endocrinology, Contraceptive Agents, couple, Reproductive Medicine, Humans, male thermal contraception, Experience And Satisfaction, sexual satisfaction
Abstract

International audience; Study question: What are the motivations, experience, and acceptability of thermal male contraception (TMC) in men using TMC as the only couple contraceptive ? Summary answer: Men wished to share the role of providing contraception in a couple and to avoid the use of hormones. Sexual satisfaction was significantly improved.What is known already: Two male contraceptive methods inducing spermatogenesis suppression have achieved contraceptive efficacy, on a large population for hormonal contraception and a smaller one for thermalcontraception (TC). The suppression of sperm counts to below 1 million/mL results in fertility rates commensurate with female pills. TC is obtained by wearing 15 hours/day a contraceptive underwear (CU) inducing a 2C increase in testicular temperature (Mieusset & Bujan 1994). As no commercially available male thermal contraceptive exists, little information regarding the acceptability of this approach to men has been reported and only one publication analysed the hypothetical acceptability of TMC (Amouroux et al. 2018). Study design, size, duration: We contacted 72 men who had started the CU testing phase between June 2011 and September 2019. The participants completed an anonymous online survey of 93 questions exploring population characteristics, contraceptive histories, motivations for choosing TC, patient experience at the successive phases of use, relations with partner and environment, and satisfaction with TC. Sexual life was evaluated by rating (1 to 4): frequency and pleasure of sexual intercourse, sexual desire, morning and intercourse erections. Participants/materials, setting, methods: Among men who had reached the contraception use phase, the quality ratings of sexual life were compared over time, from the contraceptive method used before TC (“N-1” method) to the 2 previous methods (“N-2” and “N-3”)): “N-3” versus “contraception use phase”, “N-3” versus “CU testing phase,” and “CU testing phase” versus “contraception use phase.” These comparisons were made for all 5 sexual life parameters by a paired samples Wilcoxon signed rank test. Main results and the role of chance: Sixty-seven men responded (93% response rate);63 participated in the survey (94% participation rate). The median age was 31 [21-52], 30 men (48%) had a Master’s degree or more, 49 (78%) had no child and 24 (38%) no parental project. Among the men whose couple’s contraception method immediately before TC (N-1) was a female method (n ¼ 36/63, 57%), the 2 main reasons for switching to a male method were the wish to share the role of providing contraception in a couple (n ¼ 31/36, 86%) and the willingness to take responsibility for contraception (n ¼ 21/36, 58%). The main motivations for choosing TC were “not using hormones” (n ¼ 59/63, 94%) and using a method regarded as “natural” (n ¼ 49/63, 78%). Most of men (68%) adopted the method in less than 2 weeks. During the contraception use phase (n ¼ 59 men), they described: i) significantly improved sexual satisfaction (3,49§0,29/4) compared to that experienced with previous contraceptive methods (3,27§0,58/4;p

Published
2022
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38. Determinants of hydroxychloroquine blood concentration variations in systemic lupus erythematosus

Author

M, Jallouli, L, Galicier, N, Zahr, O, Aumaître, C, Francès, V, Le Guern, F, Lioté, A, Smail, N, Limal, L, Perard, H, Desmurs-Clavel, D, Le Thi Huong, B, Asli, J-E, Kahn, J, Pourrat, L, Sailler, F, Ackermann, T, Papo, K, Sacré, O, Fain, J, Stirnemann, P, Cacoub, G, Leroux, J, Cohen-Bittan, J, Sellam, X, Mariette, B, Blanchet, J S, Hulot, Z, Amoura, J C, Piette, N, Costedoat-Chalumeau, Pierre-Jean, Weiller, Service de Médecine Interne, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5), Service d'Immunopathologie [Hôpital Saint-Louis, Paris], Université Paris Diderot - Paris 7 (UPD7)-Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de Médecine Interne [CHU Clermont-Ferrand], CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, CHU Tenon [AP-HP], Service de rhumatologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Néphrologie - Médecine Interne, CHU Amiens-Picardie-hôpital Sud, Service de médecine interne [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Hospices Civils de Lyon (HCL), Service de Médecine Interne (Med Int - Hôpital Foch), Hôpital Foch [Suresnes], Service de Néphrologie - Immunologie Clinique [Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-PRES Université de Toulouse, Service Médecine interne [CHU Toulouse], Pôle Inflammation, infection, immunologie et loco-moteur [CHU Toulouse] (Pôle I3LM Toulouse), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Hôpital Bichat - Claude Bernard, CHU Saint-Antoine [AP-HP], Department of General Medicine (Dep Gen Med - GENEVE), Hôpitaux Universitaires de Genève (HUG), Immunologie - Immunopathologie - Immunothérapie (I3), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Régulation de la réponse immune, infection VIH-1 et autoimmunité, Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Cochin [AP-HP], Département de Médecine Interne et Pneumologie [Brest] (DMIP - Brest), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Centre d'Investigation Clinique (CIC - Brest), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de dermatologie et allergologie [CHU Tenon], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Tenon [AP-HP], CHU Toulouse [Toulouse]-PRES Université de Toulouse, Service de Medecine Interne, CHU Toulouse [Toulouse], Service de rhumatologie [CHU Saint-Antoine], Unité péri-opératoire gériatrique [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Cochin [AP-HP]-Université Paris Descartes - Paris 5 ( UPD5 ), Université Paris Diderot - Paris 7 ( UPD7 ) -CHU Saint Louis [APHP], UF pharmacologie et pharmacogénétique, CHU Pitié-Salpêtrière [APHP], Service de médecine interne, hôpital Gabriel-Montpied, CHU Clermont-Ferrand, Service de dermatologie et allergologie, Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Tenon [APHP], Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Lariboisière, CHU Amiens-Picardie-Hôpital Sud, Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ), Hospices Civils de Lyon ( HCL ), Centre de Référence pour le Lupus Systémique et le Syndrome des Antiphospholipides ( CRLSSApl ), Service de Médecine Interne ( Med Int - Hôpital Foch ), CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], Service de rhumatologie, inflammation-immunopathologie- biothérapie [CHU Saint-Antoine] ( DHU i2B ), CHU Saint-Antoine [APHP]-Assistance publique - Hôpitaux de Paris (AP-HP), Department of General Medicine ( Dep Gen Med - GENEVE ), Hôpitaux Universitaires de Genève ( HUG ), Immunologie - Immunopathologie - Immunothérapie ( I3 ), Centre National de la Recherche Scientifique ( CNRS ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université Pierre et Marie Curie - Paris 6 ( UPMC ), Unité péri-opératoire gériatrique [Paris], Université Paris-Sud - Paris 11 ( UP11 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), CHU Cochin [AP-HP], Département de Médecine Interne et Pneumologie [Brest] ( DMIP - Brest ), Centre Hospitalier Régional Universitaire de Brest ( CHRU Brest ), Groupe d'Etude de la Thrombose de Bretagne Occidentale ( GETBO ), Université de Brest ( UBO ), Centre d'Investigation Clinique ( CIC - Brest ), Université de Brest ( UBO ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)

Subjects
Adult, Male, Time Factors, Neutrophils, Renal Insufficiency, Chronic/complications, [SDV]Life Sciences [q-bio], Adrenal Cortex Hormones/therapeutic use, Hydroxychloroquine/blood/pharmacokinetics/therapeutic use, Body Mass Index, Leukocyte Count, Young Adult, Adrenal Cortex Hormones, [ SDV.MHEP ] Life Sciences [q-bio]/Human health and pathology, Lupus Erythematosus, Systemic, Humans, Obesity, Renal Insufficiency, Chronic, skin and connective tissue diseases, Retrospective Studies, [ SDV ] Life Sciences [q-bio], Antirheumatic Agents/blood/pharmacokinetics/therapeutic use, Neutrophils/cytology, Lupus Erythematosus, Systemic/blood/complications/drug therapy, Creatinine/blood, Middle Aged, Thrombocytopenia, Antirheumatic Agents, Creatinine, ddc:618.97, Multivariate Analysis, Female, Obesity/complications, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Hydroxychloroquine
Abstract

International audience; Blood concentrations of hydroxychloroquine (HCQ) vary widely among patients with systemic lupus erythematosus (SLE). A pharmacokinetic/pharmacodynamic relationship has been found in different situations, and a very low blood concentration of HCQ is a simple marker of nonadherence to treatment. Therefore, interest in blood HCQ concentration measurement has increased, but little is known about factors that influence blood HCQ concentration variability. This study was undertaken to analyze determinants of blood HCQ concentrations. We conducted a retrospective analysis of patient data, including data from the Plaquenil Lupus Systemic (PLUS) study, to determine the association of epidemiologic, clinical, and biologic factors with blood HCQ concentrations. Data for nonadherent patients (blood HCQ concentration

Published
2015
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39. A national media mass campaign improves beliefs and behaviours about low back pain in the general population and in general practitioners

Author

Bailly, Florian, Badard, Martin, Beaudreuil, Johann, Beauvais, Catherine, Cazorla, C, Ohouo, Denoël, Dufour, Xavier, Petitprez, Karine, Mazza, M, Nizard, Julien, Petit, Audrey, Pham, Thao, Rannoun, Francois, Ribiniko, Patricia, Rozenberg, Sylvie, Schramm, Stéphanie, Fautrel, Bruno, Foltz, Violaine, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier de Gonesse, Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Saint-Antoine [AP-HP], Caisse primaire d'assurance maladie (CPAM), Haute Autorité de Santé [Saint-Denis La Plaine] (HAS), Centre hospitalier universitaire de Nantes (CHU Nantes), Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), École des Hautes Études en Santé Publique [EHESP] (EHESP), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), CHU Marseille, Toxicité environnementale, cibles thérapeutiques, signalisation cellulaire (T3S - UMR_S 1124), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité), Hôpital Cochin [AP-HP], national public health insurance program in France, Caisse Nationale d'Assurance Maladie, Spine section of the French Society of Rheumatology, Education therapeutic section of the French Society of Rheumatology, French Society of Rheumatology, French Society of Physiotherapy, French Society of Physical Medicine and Rehabilitation, French Society of Occupational Medicine, French College of General Medicine, and French association of fight against rheumatism

Subjects
Beliefs Conclusion A mass-media campaign aimed at the public and general practitioners in France significantly modified beliefs and behaviours about LBP, Rheumatology, [SDV]Life Sciences [q-bio], Behaviours, Low back pain, Campaign
Abstract

International audience; Introduction: Previous international mass-media campaigns for low back pain (LBP) have had conflicting impacts on the general population. The objective was to evaluate the impact of a national back pain campaign conducted between 2017 and 2019 on beliefs and behaviours of general practitioners and the general population in France.Methods: Between 2017 and 2019, a mass-media campaign was used to disseminate positive messages about LBP using several media, along with a parallel campaign addressed to general practitioners. An email survey before the campaign and 6 and 18 months after the campaign started evaluated beliefs and behaviours among a representative sample of the 2 target populations (3500 people from the gen-eral population and 700 general practitioners before the campaign, and 2000 people and 300 general practitioners 6 and 18 months after).Results: Overall, 56% of the general population respondents before the campaign and 74% and 75% at 6 and 18 months after adhered to the statement "One should maintain physical activity" when dealing with LBP. Conversely, the percentage adhering to the statement "The best treatment is resting" decreased significantly from 68% before the campaign to 45% at 6 and 18 months after. Physicians reported delivering more reassurance and giving more documentation to patients after the campaign. They prescribed less sick leave during the first consultation (65% before the campaign, 46% and 30% at 6 and 18 months after).Conclusion: A mass-media campaign aimed at the public and general practitioners in France significantly modified beliefs and behaviours about LBP.(c) 2023 Published by Elsevier Masson SAS on behalf of Socie acute accent te acute accent franc , aise de rhumatologie.

Published
2023
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40. Hypnotherapy and insomnia: A narrative review of the literature

Author

S, Mamoune, E, Mener, A, Chapron, J, Poimboeuf, CHU Pontchaillou [Rennes], Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), This work was supported by Rennes General Medicine Department of Rennes, France. This article is supported by the French network of University Hospitals HUGO (‘Hôpitaux Universitaires du Grand Ouest’)., and Jonchère, Laurent

Subjects
Advanced and Specialized Nursing, Complementary and Manual Therapy, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, Insomnia, Databases, Factual, [SDV]Life Sciences [q-bio], Review, Hypnotherapy, Clinical research, [SDV] Life Sciences [q-bio], Other systems of medicine, Complementary and alternative medicine, Research Design, Sleep Initiation and Maintenance Disorders, Humans, France, Hypnosis, RZ201-999, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; INTRODUCTION: Hypnotherapy is increasingly used in general medicine in France to manage health problems such as insomnia. There is some evidence to support the efficacy of hypnosis in treating insomnia but this evidence is based on methodologies of various strengths. This review aims to explore the methodological elements employed in hypnotherapy research to manage insomnia. METHOD: We performed a narrative review of the literature using systematic review methods focusing on treating insomnia with hypnosis. PubMed, Psycinfo, BASE and Cochrane databases and Google scholar were searched. RESULTS: Overall, 25 studies were included consisting of 10 case studies, 11 randomised, controlled trials and 4 pre and post intervention studies. The study designs, intervention, control and comparators were heterogeneous, as were the hypnosis definitions and techniques. Also, detailed descriptions of the hypnosis techniques were lacking. Most studies used non-quantifiable measurement criteria and sample numbers were too small to show significance or be representative. No double-blind study was found. CONCLUSION: Our results indicate that the current research concerning the efficacy of hypnosis to relieve insomnia is lacking in key methodological elements. The evaluation research process requires robust methodology. We propose applying the IDEAL framework, which recommends research steps to evaluate non-pharmacological and other complex therapies to evaluate the efficacy of hypnosis to manage insomnia.

Published
2022
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42. Impact of a health literacy intervention combining general practitioner training and a consumer facing intervention to improve colorectal cancer screening in underserved areas: protocol for a multicentric cluster randomized controlled trial

Author

Durand, Marie-Anne, Lamouroux, Aurore, Redmond, Niamh, Rotily, Michel, Bourmaud, Aurélie, Schott, Anne-Marie, Auger-Aubin, Isabelle, Frachon, Adèle, Exbrayat, Catherine, Balamou, Christian, Gimenez, Laëtitia, Grosclaude, Pascale, Moumjid, Nora, Haesebaert, Julie, Massy, Helene, Bardes, Julia, Touzani, Rajae, Diant, Laury, Casanova, Clémence, Seitz, Jean, Mancini, Julien, Delpierre, Cyrille, Centre d'Epidémiologie et de Recherche en santé des POPulations (CERPOP), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), Dartmouth College [Lebanon, NH, USA] (DC), Department of Epidemiology and Health Services, Center for General Medicine and Public Health, Unisanté, University of Lausanne, Assistance Publique - Hôpitaux de Marseille (APHM), Centre d'études et de recherche sur les services de santé et la qualité de vie (CEReSS), Aix Marseille Université (AMU), Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables (ECEVE (U1123 / UMR_S_1123)), Institut National de la Santé et de la Recherche Médicale (INSERM)-AP-HP Hôpital universitaire Robert-Debré [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université de Paris (UP), Research on Healthcare Performance (RESHAPE - Inserm U1290 - UCBL1), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Paris (UP), Centre Régional de Coordination du Dépistage des Cancers [Saint Étienne] (CRCDC-AuRA), Département universitaire de médecine générale [Toulouse] (DUMG), Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole (IUCT Oncopole - UMR 1037), CHU Toulouse [Toulouse]-Université Toulouse III - Paul Sabatier (UT3), Parcours santé systémique (P2S), Université de Lyon-Université de Lyon, Centre Léon Bérard [Lyon], Centre Régional de Coordination du Dépistage des Cancers [Paris] (CRCDC-IDF), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Hôpital de la Timone [CHU - APHM] (TIMONE), Centre d’Etudes et de Recherches en Psychopathologie et Psychologie de la Santé (CERPPS), Université Toulouse - Jean Jaurès (UT2J), Centre Régional de Coordination du Dépistage des Cancers [Marseille] (CRCDC-PACA), Centre universitaire de médecine générale et santé publique (Unisanté), Université de Lausanne = University of Lausanne (UNIL), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), Université Paris Cité (UPCité), Université Toulouse III Paul Sabatier - Faculté de médecine Purpan (UTPS), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées, Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Toulouse - Jean Jaurès (UT2J)-Toulouse Mind & Brain Institut (TMBI), Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3), Malbec, Odile, Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Toulouse (UT)-Université de Toulouse (UT), Université de Toulouse (UT)-Université de Toulouse (UT)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Toulouse (UT)-Université de Toulouse (UT)-Toulouse Mind & Brain Institut (TMBI), Université de Toulouse (UT)-Université de Toulouse (UT)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université Toulouse - Jean Jaurès (UT2J), Université de Toulouse (UT)-Université Toulouse III - Paul Sabatier (UT3), and Université de Toulouse (UT)

Subjects
[SDV]Life Sciences [q-bio], Medically Underserved Area, Health literacy, Intervention, General practitioner training, health disparities, Middle Aged, Colorectal cancer screening, [SDV] Life Sciences [q-bio], Study Protocol, General practitioner training, General Practitioners, Humans, Multicenter Studies as Topic, Public aspects of medicine, RA1-1270, Colorectal Neoplasms, Early Detection of Cancer, Aged, Randomized Controlled Trials as Topic, health disparities
Abstract

Background Colorectal cancer (CRC) is a leading cause of cancer burden worldwide. In France, it is the second most common cause of cancer death after lung cancer. Systematic uptake of CRC screening can improve survival rates. However, people with limited health literacy (HL) and lower socioeconomic position rarely participate. Our aim is to assess the impact of an intervention combining HL and CRC screening training for general practitioners (GPs) with a pictorial brochure and video targeting eligible patients, to increase CRC screening and other secondary outcomes, after 1 year, in several underserved geographic areas in France. Methods We will use a two-arm multicentric randomized controlled cluster trial with 32 GPs primarily serving underserved populations across four regions in France with 1024 patients recruited. GPs practicing in underserved areas (identified using the European Deprivation Index) will be block-randomized to: 1) a combined intervention (HL and CRC training + brochure and video for eligible patients), or 2) usual care. Patients will be included if they are between 50 and 74 years old, eligible for CRC screening, and present to recruited GPs. The primary outcome is CRC screening uptake after 1 year. Secondary outcomes include increasing knowledge and patient activation. After trial recruitment, we will conduct semi-structured interviews with up to 24 GPs (up to 8 in each region) and up to 48 patients (6 to 12 per region) based on data saturation. We will explore strategies that promote the intervention’s sustained use and rapid implementation using Normalization Process Theory. We will follow a community-based participatory research approach throughout the trial. For the analyses, we will adopt a regression framework for all quantitative data. We will also use exploratory mediation analyses. We will analyze all qualitative data using a framework analysis guided by Normalization Process Theory. Discussion Limited HL and its impact on the general population is a growing public health and policy challenge worldwide. It has received limited attention in France. A combined HL intervention could reduce disparities in CRC screening, increase screening rates among the most vulnerable populations, and increase knowledge and activation (beneficial in the context of repeated screening). Trial registration Registry: ClinicalTrials.gov. Trial registration number: 2020-A01687-32. Date of registration: 17th November 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11565-3.

Published
2021
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43. The Probiotic Strain H. alvei HA4597® Improves Weight Loss in Overweight Subjects under Moderate Hypocaloric Diet: A Proof-of-Concept, Multicenter Randomized, Double-Blind Placebo-Controlled Study

Author

Gregory Lambert, Barbara Grube, Clémentine Trotin-Picolo, Gordana Bothe, Constantin Erlenbeck, Pierre Déchelotte, Jonathan Breton, Sergueï O. Fetissov, Nutrition, inflammation et dysfonctionnement de l'axe intestin-cerveau (ADEN), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institute for Research and Innovation in Biomedicine (IRIB), Normandie Université (NU)-Normandie Université (NU)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), UNIROUEN - UFR Santé (UNIROUEN UFR Santé), Normandie Université (NU)-Normandie Université (NU), Service de nutrition [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), TargEDys SA, Practice for General Medicine, Analyze & Realize GmbH, Inserm UMR 1239, Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Neuroendocrine, Endocrine and Germinal Differentiation Communication (NorDic), and douville, sabine

Subjects
Male, 0301 basic medicine, Placebo-controlled study, Overweight, Gastroenterology, law.invention, 0302 clinical medicine, Randomized controlled trial, Weight loss, law, Clinical endpoint, TX341-641, Prospective Studies, Nutrition and Dietetics, Middle Aged, 3. Good health, appetite, Female, medicine.symptom, overweight subjects, Adult, medicine.medical_specialty, Adolescent, Diet, Reducing, HA4597®, 030209 endocrinology & metabolism, H. alvei HA4597, Placebo, Statistics, Nonparametric, Article, Young Adult, 03 medical and health sciences, Double-Blind Method, Internal medicine, Weight Loss, medicine, Humans, Obesity, Exercise, Aged, hip circumference, gut microbiota, Nutrition. Foods and food supply, business.industry, Body Weight, Hafnia alvei, medicine.disease, Gastrointestinal Microbiome, feeling of fullness, [SDV.AEN] Life Sciences [q-bio]/Food and Nutrition, 030104 developmental biology, probiotics, Anti-Obesity Agents, business, Weight gain, [SDV.AEN]Life Sciences [q-bio]/Food and Nutrition, Food Science
Abstract

Background: Increasing evidence supports the role of the gut microbiota in the control of body weight and feeding behavior. Moreover, recent studies have reported that the probiotic strain Hafnia alvei HA4597® (HA), which produces the satietogenic peptide ClpB mimicking the effect of alpha-MSH, reduced weight gain and adiposity in rodent models of obesity. Methods: To investigate the clinical efficacy of HA, 236 overweight subjects were included, after written informed consent, in a 12-week prospective, double-blind, randomized study. All subjects received standardized counselling for a −20% hypocaloric diet and were asked to maintain their usual physical activity. Subjects of the HA group received two capsules per day providing 100 billion bacteria per day and subjects in the Placebo (P) group received two placebo capsules. The primary endpoint was the percentage of subjects achieving a weight loss of at least 3% after 12 weeks. Intention-to-treat statistical analysis was performed using exact-Fischer, Mann-Whitney and paired-Wilcoxon tests as appropriate. Results: In the HA group, significantly more subjects (+33%) met the primary endpoint than in the P group (54.9 vs. 41.4%, p = 0.048). In the HA group, an increased feeling of fullness (p = 0.009) and a greater loss of hip circumference (p &lt, 0.001) at 12 weeks were also observed. Fasting glycemia at 12 weeks was significantly lower (p &lt, 0.05) in the HA compared to P group. Clinical and biological tolerance was good in both groups. Conclusions: A 12-week treatment with the probiotic strain H. alvei HA4597® significantly improves weight loss, feeling of fullness and reduction of hip circumference in overweight subjects following moderate hypocaloric diet. These data support the use of H. alvei HA4597® in the global management of excess weight.

Published
2021
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45. Monitoring of pesticides in ambient air: Prioritization of substances

Author

Arnaud Boivin, Pierre Pernot, Catherine Chubilleau, Carole Leroux, Anne-Laure Scelo, Aurélie Berthet, Aurélien Gouzy, Aurélie Mathieu, Eva Leoz Garziandia, Agnès Hulin, Marion Hulin, Laure Mamy, Bernard Bonicelli, Mathilde Merlo, Bernadette Ruelle, Maurice Millet, Etienne Quivet, Carole Bedos, Direction de l'Evaluation des Risques (DER), Agence nationale de sécurité sanitaire de l'alimentation, de l'environnement et du travail (ANSES), Institut National de l'Environnement Industriel et des Risques (INERIS), Centre universitaire de médecine générale et santé publique (Unisanté), Université de Lausanne = University of Lausanne (UNIL), Direction de l'évaluation des produits réglementés (DEPR), Information – Technologies – Analyse Environnementale – Procédés Agricoles (UMR ITAP), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Institut Agro - Montpellier SupAgro, Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro), ATMO Poitou-Charentes, ATMO, LCSQA - Laboratoire Central de Surveillance de la Qualité de l’Air, Ecologie fonctionnelle et écotoxicologie des agroécosystèmes (ECOSYS), AgroParisTech-Université Paris-Saclay-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Institut de chimie et procédés pour l'énergie, l'environnement et la santé (ICPEES), Université de Strasbourg (UNISTRA)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Matériaux et Nanosciences Grand-Est (MNGE), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), AIRPARIF - Surveillance de la qualité de l'air en Île-de-France, Laboratoire Chimie de l'environnement (LCE), Aix Marseille Université (AMU)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), Department of Epidemiology and Health Services, Center for General Medicine and Public Health, Unisanté, University of Lausanne, Institut national d’études supérieures agronomiques de Montpellier (Montpellier SupAgro), Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Université de Strasbourg (UNISTRA)-Matériaux et nanosciences d'Alsace (FMNGE), Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre National de la Recherche Scientifique (CNRS), and Centre National de la Recherche Scientifique (CNRS)-Aix Marseille Université (AMU)-Institut de Chimie du CNRS (INC)

Subjects
Pollution, Prioritization, Environmental Engineering, 010504 meteorology & atmospheric sciences, Monitoring, media_common.quotation_subject, Decision tree, 010501 environmental sciences, 01 natural sciences, Exposure, [CHIM.ANAL]Chemical Sciences/Analytical chemistry, Environmental Chemistry, Relevance (information retrieval), Active substances, Pesticides, Waste Management and Disposal, 0105 earth and related environmental sciences, media_common, [SDU.OCEAN]Sciences of the Universe [physics]/Ocean, Atmosphere, business.industry, Environmental resource management, Pesticide, Antiparasitic agent, Hazard, Ambient air, Product (business), Work (electrical), 13. Climate action, [SDE]Environmental Sciences, Environmental science, business
Abstract

International audience; Despite the richness of data collected on pesticide concentrations in ambient air in France, knowledge on this topic remains partial and heterogeneous in the absence of specific regulations. The population exposure remains thus difficult to estimate; therefore it was necessary to define modalities for implementing national monitoring of pesticides in ambient air in metropolitan France and in the overseas territories. The objective of this work was to identify which active substances (a.s.) have to be monitored in priority. As part of a collective expertise, a group of multidisciplinary experts has developed a method to rank active substances authorised as plant protection products, biocides and antiparasitic agents, which were available on the French market in 2015. A 3-steps approach has been developed. The first step consisted of a theoretical approach based on a hierarchy of substances according to four criteria: (a) national uses, (b) emission potential to the air, (c) persistence in the air, and (d) chronic toxicity. The three first criteria give information on their potential to be present in the atmosphere, and the fourth criterion allows to consider their potential of hazard. The second step was an observational approach based on existing database on pesticide air measurements in France. In the third step, both approaches were combined using decision trees to select priority pesticides. Among the 1316 a.s. first identified from the EU Pesticides database, 90 were selected, among which 43 required metrological and/or analytical development. The experts recommended confirming the relevance of performing a longer term monitoring of these a. s. after a one-year exploratory campaign. The proposed method is reproduceable, transparent, easy to update (e.g. in the light of a change in product authorization), and can be adapted to other agricultural and geographical conditions, and objectives (e.g. monitoring of the ecotoxicological effects of pesticides).

Published
2021
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46. Assessment of Inorganic Phosphate Intake by the Measurement of the Phosphate/Urea Nitrogen Ratio in Urine

Author

Arnold J. Felsenfeld, María Dolores López-Zamorano, Cristina Membrives-González, Francisco Caravaca, Rafael Santamaria, Noemi Vergara, Eugenio J De la Torre, Sagrario Soriano, Rodrigo López-Baltanás, Mariano Rodriguez, Maria Victoria Pendon-Ruiz de Mier, Cristian Rodelo-Haad, Juan R. Muñoz-Castañeda, Alejandro Martin-Malo, [Pendón-Ruiz de Mier,MV, Vergara,N, Rodelo-Haad,C, Membrives-González,C, López-Baltanás,R, Muñoz-Castañeda,JR, Martín-Malo,A, Soriano,S, Santamaría,R, Rodríguez,M] Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Reina Sofia University Hospital, Nephrology Service, University of Cordoba, Cordoba, Spain. [Pendón-Ruiz de Mier,MV, Santamaría,R] Spanish Renal Research Network (REDinREN), Institute of Health Carlos III, Madrid, Spain. [López-Zamorano,MD] Nephrology Service, Reina Sofia University Hospital, Cordoba, Spain. [Muñoz-Castañeda,JR, Rodríguez,M] EUTOXandCKD-MBD groups of the ERA-EDTA, Spanish Renal Research Network (REDinREN), Institute of Health Carlos III, Madrid, Spain. [Caravaca,F] Nephrology Service, Infanta Cristina Hospital, Badajoz, Spain. [Felsenfeld,AJ] Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System and the David Geffen School of Medicine, University of California, Los Angeles, USA. [De la Torre,EJ] General Medicine, Miguelturra Clinic, Ciudad Real, Spain., and This work was supported by a Spanish government grant from the Programa Nacional I+D+I 2013–2016 and Instituto de Salud Carlos III (ISCIII) Grants PI18/0138, PI17/01010 co-financing from European Funds (FEDER), Consejería de Salud and EUTOX and REDinREN from the ISCIII. J.R.M.-C. is senior researcher supported by the Nicolás Monardes Programme, Consejería de Salud-Servicio Andaluz de Salud (Junta de Andalucía).

Subjects
Factor de crecimiento fibroblástico 23, Male, phosphate intake, 030232 urology & nephrology, Urine, 030204 cardiovascular system & hematology, Intestinal absorption, Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings], chemistry.chemical_compound, Eating, 0302 clinical medicine, FGF23, Organisms::Eukaryota::Animals [Medical Subject Headings], Urea, Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Rodentia::Muridae::Murinae::Rats::Rats, Wistar [Medical Subject Headings], Insuficiencia renal crónica, Persons::Persons::Age Groups::Adult::Aged [Medical Subject Headings], Nutrition and Dietetics, Chemicals and Drugs::Organic Chemicals::Urea [Medical Subject Headings], Urea nitrogen, Middle Aged, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cross-Sectional Studies [Medical Subject Headings], phosphaturia, Hormona paratiroidea, Female, lcsh:Nutrition. Foods and food supply, PTH, Adult, Hipofosfatemia familiar, Urinary system, Check Tags::Male [Medical Subject Headings], lcsh:TX341-641, Phenomena and Processes::Physiological Phenomena::Nutritional Physiological Phenomena::Diet [Medical Subject Headings], Article, Phosphates, 03 medical and health sciences, Inorganic phosphate, Animal science, medicine, CKD, Animals, Humans, Rats, Wistar, Persons::Persons::Age Groups::Adult [Medical Subject Headings], Aged, Persons::Persons::Age Groups::Adult::Middle Aged [Medical Subject Headings], Chemicals and Drugs::Biological Factors::Intercellular Signaling Peptides and Proteins::Fibroblast Growth Factors [Medical Subject Headings], medicine.disease, Phosphate, Diet, Rats, Chemicals and Drugs::Inorganic Chemicals::Acids::Acids, Noncarboxylic::Phosphorus Acids::Phosphoric Acids::Phosphates [Medical Subject Headings], Fibroblast Growth Factor-23, Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Rodentia::Muridae::Murinae::Rats [Medical Subject Headings], Cross-Sectional Studies, chemistry, Check Tags::Female [Medical Subject Headings], Metabolic syndrome, Food Science, Kidney disease
Abstract

In chronic kidney disease (CKD) patients, it would be desirable to reduce the intake of inorganic phosphate (P) rather than limit the intake of P contained in proteins. Urinary excretion of P should reflect intestinal absorption of P(inorganic plus protein-derived). The aim of the present study is to determine whether the ratio of urinary P to urinary urea nitrogen (P/UUN ratio) helps identify patients with a high intake of inorganic P.A cross-sectional study was performed in 71 patients affected by metabolic syndrome with CKD (stages 2&ndash, 3) with normal serum P concentration. A 3-day dietary survey was performed to estimate the average daily amount and the source of P ingested. The daily intake of P was 1086.5 &plusmn, 361.3 mg/day, 64% contained in animal proteins, 22% in vegetable proteins, and 14% as inorganic P. The total amount of P ingested did not correlate with daily phosphaturia, but it did correlate with the P/UUN ratio (p &lt, 0.018). Patients with the highest tertile of the P/UUN ratio &gt, 71.1 mg/g presented more abundant inorganic P intake (p &lt, 0.038).The P/UUN ratio is suggested to be a marker of inorganic P intake. This finding might be useful in clinical practices to identify the source of dietary P and to make personalized dietary recommendations directed to reduce inorganic P intake.

Published
2021
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47. G protein-coupled receptor-effector macromolecular membrane assemblies (GEMMAs)

Author

Francisco Ciruela, Diomedes E. Logothetis, Javier González-Maeso, Carmen W. Dessauer, Ralf Jockers, Sergi Ferré, Terence E. Hébert, Leonardo Pardo, Department of Health and Human Services [Baltimore, MD, USA] (DHHS), Institut d'Investigació Biomèdica de Bellvitge [Barcelone] (IDIBELL), University of Texas Health Science Center, The University of Texas Health Science Center at Houston (UTHealth), Virginia Commonwealth University (VCU), Department of Pharmacology and Therapeutics [Montréal], McGill University = Université McGill [Montréal, Canada], Institut Cochin (IC UM3 (UMR 8104 / U1016)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité), Department of Health Sciences, Northeastern University [Boston]-College of Computer and Information Sciences, University of Barcelona, This article was written as the result of a roundtable meeting of the coauthors at the University of Barcelona in February 2020, organized by the Esteve Foundation and the Institute of Neurosciences of the University of Barcelona. S.F. is supported with the intramural funds of the National Institute on Drug Abuse. C.W.D. is supported by the National Institute of General Medicine (GM60419). J.G.-M. is supported by the National Institute of Mental Health (R01MH084894 and R01MH111940). D.E.L. is supported by the National Institute of Heart, Lung and Blood Institute (HL09549-24). T.E.H. holds the Canadian Pacific Chair in Biotechnology. F.C. and L.P. are supported by FEDER-EU/'Ministerio de Ciencia, Innovación y Universidades-Agencia Estatal de Investigación' (PID2020-118511RB-I00). R.J. is supported by 'Agence Nationale de la Recherche' (ANR-19-CE16-0025-01), 'Fondation de la Recherche Médicale' (FRM DEQ20130326503), 'Institut National de la Santé et de la Recherche Médicale and 'Centre National de la Recherche Scientifique'., ANR-19-CE16-0025,mitoGPCR,Les récepteurs couplés aux protéines G mitochondriaux en neuroprotection(2019), Université Paris Cité, Equipe HAL, and Les récepteurs couplés aux protéines G mitochondriaux en neuroprotection - - mitoGPCR2019 - ANR-19-CE16-0025 - AAPG2019 - VALID

Subjects
Cell signaling, G protein, GPCR oligomerization, Cell, Proteïnes G, Article, Receptors, G-Protein-Coupled, G protein-coupled receptors, GPCR allosterism, GTP-Binding Proteins, Heterotrimeric G protein, medicine, Humans, Pharmacology (medical), Receptor, G protein-coupled receptor, Cell receptors, Pharmacology, Effector, Chemistry, Plasma membrane effector, Cell Membrane, Transmembrane protein, Cell biology, Cell membranes, medicine.anatomical_structure, [SDV.SP.PHARMA] Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, G protein subnits, [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, Receptors cel·lulars, G Proteins, Membranes cel·lulars, hormones, hormone substitutes, and hormone antagonists, Signal Transduction
Abstract

International audience; G protein-coupled receptors (GPCRs) are the largest group of receptors involved in cellular signaling across the plasma membrane and a major class of drug targets. The canonical model for GPCR signaling involves three components — the GPCR, a heterotrimeric G protein and a proximal plasma membrane effector — that have been generally thought to be freely mobile molecules able to interact by ‘collision coupling’. Here, we synthesize evidence that supports the existence of GPCR–effector macromolecular membrane assemblies (GEMMAs) comprised of specific GPCRs, G proteins, plasma membrane effector molecules and other associated transmembrane proteins that are pre-assembled prior to receptor activation by agonists, which then leads to subsequent rearrangement of the GEMMA components. The GEMMA concept offers an alternative and complementary model to the canonical collision-coupling model, allowing more efficient interactions between specific signaling components, as well as the integration of the concept of GPCR oligomerization as well as GPCR interactions with orphan receptors, truncated GPCRs and other membrane-localized GPCR-associated proteins. Collision-coupling and pre-assembled mechanisms are not exclusive and likely both operate in the cell, providing a spectrum of signaling modalities which explains the differential properties of a multitude of GPCRs in their different cellular environments. Here, we explore the unique pharmacological characteristics of individual GEMMAs, which could provide new opportunities to therapeutically modulate GPCR signaling.

Published
2021
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48. Frailty, Sarcopenia and Long Term Care Utilization In Older Populations: A Systematic Review

Author

Thomas Rapp, Jonathan Sicsic, Nicolas Sirven, B. Santos-Eggimann, Quitterie Roquebert, Laboratoire Interdisciplinaire de Recherche Appliquée en Economie de la Santé (LIRAES (URP_ 4470)), Université de Paris (UP), Department of Epidemiology and Health Services, Center for General Medicine and Public Health, Unisanté, University of Lausanne, Laboratoire interdisciplinaire d'évaluation des politiques publiques [Sciences Po] (LIEPP), and Sciences Po (Sciences Po)

Subjects
Gerontology, medicine.medical_specialty, Sarcopenia, CINAHL, 03 medical and health sciences, Pharmacoeconomics, Long-term care, 0302 clinical medicine, Outcome Assessment, Health Care, Medicine, Humans, 030212 general & internal medicine, Aged, Personal care, Frailty, business.industry, Nursing home, 030503 health policy & services, General Medicine, medicine.disease, Informal care, 3. Good health, Nursing Homes, Formal care, Short stay, Systematic review, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Outcomes research, 0305 other medical science, business
Abstract

International audience; This systematic literature review documents the link between frailty or sarcopenia, conceptualized as dimensions of physical health, and the use of long-term care services by older individuals. Long-term care services include formal and informal care provided at home as well as in institutions. A systematic review was performed according to PRISMA requirements using the following databases: PubMed-Medline, Embase, CINAHL, Web of Science, and Academic Search Premier. We included all quantitative studies published in English between January 2000 and December 2018 focusing on individuals aged 50 or more, using a relevant measurement of sarcopenia or physical frailty and a long-term care related outcome. A quality assessment was carried out using the questionnaire established by the Good Practice Task Force Report of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Five subsets of long-term care outcome were considered: 1/ nursing home placement (NHP), 2/ nursing home short stay (NHSS), 3/ formal personal care (FPC), 4/ formal home help (FHH), 5/ informal care (IC). Out of 1943 studies, 17 were finally included in the review. With some studies covering several LTC outcomes, frailty and / or sarcopenia were associated with increased LTC use in 17 out of 26 cases (NHP: 5/6, NHSS: 3/4, FPC: 5/7, FHH: 1/4, IC: 3/5) The association was not consistent in 5 cases (NHP: 1/6, NHSS: 1/4, FPC: 2/7, FHH: 0/4, IC: 1/5) and the association was either not significant or the results inconclusive in the remaining 9 cases. Overall, while results on sarcopenia are scarce, evidence support a positive association between frailty and LTC use. The evidence is stronger for the association of physical frailty with nursing home placement / short stay as well as on FPC. There is less (more heterogeneous) evidence regarding the correlation between physical frailty and FHH or IC use. Results need to be confirmed by more advanced statistical methods or design based on longitudinal data.

Published
2021
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49. Protective Effect on Mortality of Active Commuting to Work: A Systematic Review and Meta-analysis

Author

Séverine Pélangeon, Bruno Pereira, Martine Duclos, Philippe Vorilhon, Frédéric Dutheil, Valentin Navel, Julien S. Baker, Martial Mermillod, Laboratoire de Psychologie Sociale et Cognitive (LAPSCO), Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS), Service Santé Travail Environnement [CHU Clermont-Ferrand], CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, WittyFit, Australian Catholic University (ACU), General Medicine, AMUAC, 63000, Clermont-Ferrand, France, Unité de Nutrition Humaine (UNH), Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), AutomédiCation aCcompagnement Pluriprofessionnel PatienT (ACCePPT), Université Clermont Auvergne [2017-2020] (UCA [2017-2020]), Laboratoire de Psychologie et NeuroCognition (LPNC ), Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA), Institut Universitaire de France (IUF), Ministère de l'Education nationale, de l’Enseignement supérieur et de la Recherche (M.E.N.E.S.R.), Centre for Health and Exercise Science Research, Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong, Unité de Biostatistiques [CHU Clermont-Ferrand], Direction de la recherche clinique et de l’innovation [CHU Clermont-Ferrand] (DRCI), Génétique, Reproduction et Développement (GReD), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS), Service d'ophtalmologie [Clermont-Ferrand], CHU Clermont-Ferrand, ANR-19-P3IA-0003,MIAI,MIAI @ Grenoble Alpes(2019), Centre National de la Recherche Scientifique (CNRS)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Institut National de la Santé et de la Recherche Médicale (INSERM), LAPSCO, HAL, and MIAI @ Grenoble Alpes - - MIAI2019 - ANR-19-P3IA-0003 - P3IA - VALID

Subjects
Physical Therapy, Sports Therapy and Rehabilitation, Transportation, Walking, 030204 cardiovascular system & hematology, Cochrane Library, Intermediate level, 03 medical and health sciences, 0302 clinical medicine, Risk of mortality, Medicine, Humans, Orthopedics and Sports Medicine, 030212 general & internal medicine, Mortality, Cardiovascular mortality, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, business.industry, Confidence interval, 3. Good health, Bicycling, Mortality data, Meta-analysis, Sedentary Behavior, business, Cycling, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Demography
Abstract

International audience; Background: Sedentary behaviour is a major risk of mortality. However, data are contradictoryregarding the effects of active commuting on mortality.Objectives: To perform a systematic review and meta-analysis on the effects of activecommuting on mortality.Method: The PubMed, Cochrane Library, Embase, and Science Direct databases were searchedfor studies reporting mortality data and active commuting (walking or cycling) to or from work.We computed meta-analysis stratified on type of mortality, type of commuting, and level ofcommuting, each with two models (based on fully adjusted estimates of risks, and on crude orless adjusted estimates).Results: 17 studies representing 829 098 workers were included. Using the fully adjustedestimates of risks, active commuting decreased all-cause mortality by 9% (95% confidenceintervals 3 to 9%), and cardiovascular mortality by 15% (3 to 27%) (p

Published
2020
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50. The association between cervical cancer screening participation and the deprivation index of the location of the family doctor’s office

Author

Claire Collins, Jonathan Favre, Ludivine Launay, Fanny Serman, Lydia Guittet, Christophe Berkhout, Michaël Rochoy, Valérie Deken, Nassir Messaadi, Thibaut Raginel, Alain Duhamel, Université Lille 2 - Faculté de Médecine, CHU Lille, Unité de Recherches et d'Evaluations en Epidémiologie [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN)-Centre Régional de Lutte contre le Cancer François Baclesse [Caen] (UNICANCER/CRLC), UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU)-UNICANCER, Unité de recherche interdisciplinaire pour la prévention et le traitement des cancers (ANTICIPE), UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU)-UNICANCER-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Médecine générale [CHU Caen], Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Irish College of General Practitioners [Dublin, Irlande] (ICGP), This study was granted by the French Ministry of Health (PREPS: LIC-14-14-0615, 12/19/2014) and sponsored by the University Hospital of Lille., Faculté de Médecine Henri Warembourg - Université de Lille, Normandie Université (NU)-Normandie Université (NU)-Centre Régional de Lutte contre le Cancer François Baclesse [Caen] (UNICANCER/CRLC), UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU)-UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Régional de Lutte contre le Cancer François Baclesse [Caen] (UNICANCER/CRLC), Bodescot, Myriam, Department of General Medicine [Lille], School of Medicine [Lille], Université de Lille-Université de Lille, Department of Public Health [Lille], Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), and Irish College of General Practitioners [Dublin, Irlande]

Subjects
Male, Health Screening, Medical Doctors, Economics, Health Care Providers, Uterine Cervical Neoplasms, Social Sciences, Cervical Cancer, Geographical locations, 0302 clinical medicine, Medicine and Health Sciences, Public and Occupational Health, 030212 general & internal medicine, Medical Personnel, Early Detection of Cancer, Cervical cancer, Multidisciplinary, Cervical screening, Physicians, Family, Physician Office, Census, Middle Aged, Socioeconomic Aspects of Health, 3. Good health, Europe, Professions, Oncology, Research Design, 030220 oncology & carcinogenesis, Medicine, Female, Doctor's office, France, Cancer Screening, Papanicolaou Test, Research Article, Adult, medicine.medical_specialty, Science, [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Social class, Research and Analysis Methods, Interviews as Topic, 03 medical and health sciences, Health Economics, [SDV.CAN] Life Sciences [q-bio]/Cancer, Diagnostic Medicine, medicine, Cancer Detection and Diagnosis, Humans, European Union, Socioeconomic status, Aged, Vaginal Smears, Insurance, Health, Survey Research, Poverty, business.industry, Cancers and Neoplasms, medicine.disease, Physicians' Offices, Health Care, [SDV.MHEP.GEO] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Social Class, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Family medicine, People and Places, Population Groupings, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, Food Deprivation, Gynecological Tumors, Health Insurance
Abstract

International audience; Background: Cervical cancer screening rates are known to be strongly associated with socioeconomic status. Our objective was to assess whether the rate is also associated with an aggregated deprivation marker, defined by the location of family doctors' offices.Methods: To access this association, we 1) collected data from the claim database of the French Health Insurance Fund about the registered family doctors and their enlisted female patients eligible for cervical screening; 2) carried out a telephone survey with all registered doctors to establish if they were carrying out Pap-smears in their practices; 3) geotracked all the doctors' offices in the smallest existing blocks of socioeconomic homogenous populations (IRIS census units) that were assigned a census derived marker of deprivation, the European Deprivation Index (EDI), and a binary variable of urbanization; and 4) we used a multivariable linear mixed model with IRIS as a random effect.Results: Of 348 eligible doctors, 343 responded to the telephone survey (98.6%) and were included in the analysis, encompassing 88,152 female enlisted patients aged 25-65 years old. In the multivariable analysis (adjusted by the gender of the family doctor, the practice of Pap-smears by the doctor and the urbanization of the office location), the EDI of the doctor's office was strongly associated with the cervical cancer screening participation rate of eligible patients (p

Published
2020
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